Does your health insurance company have the right to discriminate and go against your doctors care?

UPDATED: Nov 5, 2012

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Does your health insurance company have the right to discriminate and go against your doctors care?

My spinal surgeon says that I need lumbar fusion surgery and insurance refuses claim.

Asked on November 5, 2012 under Insurance Law, Tennessee


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

Your insurer does not have to pay for any and every procedure. Insurers can decline to pay if they believe that the procedure is inappropriate, unproven, not helpful, etc. That does not mean they are  right to do so in this case, only that circumstances exist under which they may refuse. You should consult with an attorney, preferably one with health care/health insurance experience, to see if you have grounds to force your insurer to pay in this case.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

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